Spitz/Reed nevi: a review of clinical-dermatoscopic and histological correlation

Abstract

Background: Spitz/Reed nevi are melanocytic lesions that may mimic melanoma at clinical, dermatoscopic and histopathological levels. Management strategies of these lesions remain controversial.

Objectives: We aim a correlation among clinical-dermatoscopic and histological features of a series of Spitz/Reed nevi diagnosed during 7 years at the Department of Dermatology.

Methods: Clinical, dermatoscopic and histological features of Spitz/Reed nevi diagnosed at our tertiary hospital from 2008 to 2014 were reviewed in order to seek correlation.

Results: All described dermatoscopic patterns for Spitz/Reed nevi were found among the 47 enrolled patients; starburst and atypical/multicomponent patterns prevailed (57.4%). Reticular pattern predominated among children younger than 12 years, whereas homogeneous pattern was more frequent in patients older than 12 years, although these differences were not statistically significant (P=0.785). Among histological atypical lesions, all dermatoscopic patterns were represented, but the atypical/multicomponent predominated (56.3%). Two out of 11 dermatoscopically atypical lesions did not show histopathological counterpart.

Conclusions: The excision of Spitz/Reed nevi in adults is supported, given the inability to accurately predict those with histopathological atypia, based on clinical and dermatoscopic features, which may raise concern about malignancy.

Keywords: Reed nevus; Spitz nevus; dermatoscopy; spindle and/or epithelioid cell nevus.

Figure 1.

Black-colored, flat lesion on the right thigh of an 11-year-old female child. (A) A superficial black network emerges under the dermatoscopic examination, overlying a diffuse bluish pigmentation. (B) Histopathology shows a junctional melanocytic lesion with focal areas of pigmented parakeratosis (black arrow) which explains the superficial black network seen in (A). The dense band of superficial dermal melanophages is thought to be responsible for the bluish background (HE, ×20). Pigmented spindle-shaped melanocytes predominate in well-demarcated junctional nests (insets, ×100 and ×200). [Copyright: ©2016 Pedrosa et al.]

Figure 2.

Brown-colored lesion on the left arm of a 33-year-old female. (A) This atypical/multicomponent patterned lesion is dermatoscopically asymmetric typified by pseudopods irregularly distributed at the periphery and an atypical network attenuated at the right side. (B) Histopathology unveils a junctional asymmetric lesion with epidermal hyperplasia, hyperkeratosis and hypergranulosis exhibiting a focal infiltration of dermal melanophages responsible for the blue-whitish veil seen under dermoscopy (HE, ×40). Confluent epithelioid and spindle-shaped melanocyte nests are observed in insets (HE, ×100 and ×200). [Copyright: ©2016 Pedrosa et al.]

Figure 3.

A pink pale papule on the face of a 5-year-old female child. (A) A homogeneous pink-red pattern exhibiting dermatoscopically dotted and linear vessels and sparse pigmented globules not apparent at naked eye examination. (B) Histopathology shows a compound, symmetrical lesion with shallow depth, well-demarcated borders and a marked dermal inflammatory cell infiltrate in lower magnification (HE, ×40). Epithelioid and spindle-cell nests of melanocytes and sparse melanophages are observed, as well as scant pigment deposition (inset, ×200). [Copyright: ©2016 Pedrosa et al.]